Massive PE Thrombolysis — FRCA Final MCQ

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HardIntensive Care MedicineMassive PE ThrombolysisFRCA Final

An ICU patient on day 14 develops a new saddle PE with RV dysfunction on echo and haemodynamic instability. What is the most appropriate treatment?

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Correct answer: E — Systemic thrombolysis with alteplase

Massive PE (haemodynamic instability + RV dysfunction) = indication for systemic thrombolysis. Alteplase 10 mg IV bolus then 90 mg over 2 hours is the standard regimen. If thrombolysis contraindicated or fails: surgical embolectomy or catheter-directed therapy. UFH is adjunctive, not definitive for massive PE.

Reference: NICE – 2023 – VTE management; ESC – 2024 – Pulmonary embolism guidelines